柠檬酸杆菌属医院感染特性与多药耐药分析  

Character of Hospital Infection and Multidrug Resistance of Citrobacter

作　　者：俞锡灿[1] 朱美英[1] 张德忠 

机构地区：[1]浙江省新昌县人民医院检验科,浙江新昌县312500 [2]浙江省青田县人民医院检验科,浙江青田县323900

出　　处：《中华医院感染学杂志》2009年第12期1603-1605,共3页Chinese Journal of Nosocomiology

摘　　要：目的调查医院柠檬酸杆菌属感染的菌群分布、产酶的特性和对抗菌药物的耐药性,分析其多药耐药(MDR)特点,指导临床用药。方法对临床分离147株柠檬酸杆菌属,采用三维试验检测超广谱β-内酰胺酶(ESBLs)和AmpC酶,用双纸片协同试验检测金属β-内酰胺酶(MBL),并使用K-B纸片琼脂扩散法测定其对15种抗菌药物的耐药性。结果柠檬酸杆菌属医院感染以弗氏柠檬酸杆菌为主,其次是无丙二酸柠檬酸杆菌,ICU的分离率与内、外科、其他病区相比差异无统计学意义(P>0.05);呼吸道与泌尿道感染率相近,明显高于其他部位(P<0.01);柠檬酸杆菌属总分离株的ESBLs、AmpC、同产ESBLs和AmpC、MBL检出率分别为36.05%、10.20%、7.48%和2.72%,总分离株对亚胺培南、美罗培南的耐药率分别为4.76%、3.40%,其次是对头孢哌酮/他唑巴坦为23.81%;对其余抗菌药物的耐药率均>40.00%;非ICU和ICU多药耐药菌分别占53.64%和81.08%,两组病房差异有统计学意义(P<0.01)。结论医院感染的柠檬酸杆菌属ESBLs产酶率高,且大多呈多药耐药,亚胺培南、美罗培南、头孢哌酮/他唑巴坦对其具有良好的抗菌活性。OBJECTIVE To investigate the flora distribution, enzyme producing and drug resistance of Citrobacter in our hospital, and analyzed multi drug resistance（MDR） character in order to guide the clinical medication. METHODS Totally 147 clinical isolates of Citrobacter were detected out ESBLs and AmpC β-lactamases by threedimensional test, MBL by the double-disk synergy test. at the same time, drug resistance to fifteen antibiotics was also detected by K-B method. RESULTS Hospital infection caused by Citrobacter. most commonly by C. freundii and then C. arnalonaticus. Respiratory tract and urinary tract were prone to be infected than other sites （P〈0.01）, but ICU patients were not easier to catch infection than medical ward, surgical ward and other wards （P〉0.05）. The rate of ESBLs, AmpC, ESBLs＋AmpC and MBL which produced by Citrobacter were 36.05% 10.20%, 7.48% and 2.72%. The Citrobacter were sensitive to imipenem and meropenem, and their resistance rates to imipenem and meropenem were 4.76% and 3. 40%, respectively. The resistance rate to cefoperazone/ tazobactam was 23. 81%. Otherwise, the resistance rate to 12 kinds of other antibiotics were all higher than 40.0%. MDR strains in the ICU ward were 81. 08%, while in other wards were 53. 64%, with significant difference（P〈0. 01）. CONCLUSIONS Citrobacter that caused hospital infection in our hospital are prone to produce enzyme（ESBLs）, and most of them are MDR, but imipenem, meropenem and cefoperazone/tazobactam are the effective antibiotics against the Citrobacter from hospitalized patients.

关 键 词：柠檬酸杆菌属 Β-内酰胺酶 耐药性 多药耐药 

分 类 号：R378[医药卫生—病原生物学]